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Home My WebLink About42711-Z TOWN OF SOUTHOLD a�o�gUFPD(,�coGy� BUILDING DEPARTMENT CA z TOWN CLERKS OFFICE o . g SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 42711 Date: 5/22/2018 Permission is hereby granted to: Sixsmith, Diane 817 West End Ave Apt 9C New York, NY 100255321 To: install deer fence as applied for. At premises located at: 540 Poquatuck Ln, Orient SCTM # 473889 Sec/Block/Lot# 27.-3-4.4 Pursuant to application dated 5/9/2018 and approved by the Building Inspector. To expire on 11/30/2019. Fees: DEER FENCE $75.00 Total: $75.00 a 1Z Buil pector TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building,Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey South oldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20JIN Single&Separate Truss Identification Form Storm-Water Assessment Form (� Contact: Approved o`er ,20 Mail•to:' Disapproved a/c Phone: Expiration 20 _4_ Buil Ui ec r D MAY Z018 APPLICATION FOR BUILDING PERMIT Date c , 20 J �'® �G �-PT INSTRUCTIONS wN®F So�®L , a. This application ST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shat l be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy, f. Every building permit shall expire if the work authorized-has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.,If no-zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, anew,permit shall be required. APPLICATION IS HEREBY MADE to the•Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York, and other applicable Laws,Ordinances or Regulations, for the construction of buildings, additions,or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code,ho ' g code, and regulat%•ns, and to admi ' authorized inspectors on premises and in building for necessary inspections. (Signature d a61i!6L or name,if a corporation) &K Z7� Orie44A (Mailing address of applicant) J f qJ 7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises �� ! �5 / (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. , 1. Location of land on w 'ch propo ed work will be done: House Number Street )Hamlet', County Tax Map No. 1000 Section Block,,, ��✓// Lot �� Subdivision FiledMap No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy r C 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work e- (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number o dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nat e and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height .Number of Storie Dimensions of same structure with alteratio or additions: Front Rear Depth Height Number of Stories = '+ 8. Dimensions of entire new construction: Fro Rear p Stories' Height Number of 4 L 9. Size of lot: Front ar. Depth , 10. Date of Purchase Name of Former Owner �" �g" 11. Zone or use district in which prem' es are situated 12. Does proposed construction vio ate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO /Will excess fill be.removed.from premises? YES NO 14. Names of Owner of pre ses Address Phone No. Name of Architect Address Phone No Name of Contractor y 4 r— Address F Phone No. be3%. 74 J" 4/%' r SLLa j11y 1/g3J 15 a. Is this property within 100 feet of a tidal wetland or a freshwater•wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES'& D.E.G. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. G. Yovide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. e covenants and restrictions with respect to thisproperty? * YES NO 18. Are there any p * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) being duly swom, deposes and says that(s)he is the applicant (Name of individual si ontract)above named, (S)He is the (Contractor,Agent, Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /� day of I1/1 w 20 LAV�Cl sZV&/6oNI L STARON Not ublic PubState of New Yo Si ature of A licant No.01ST6239228 � pp Qualified in Suffolk county Commission FxAires Aodl 18.20 1 • r SUFFOLK CO. HEALTH DEPT. APPROVAL .s .^f � . -r ~'sf ✓. G�irY . :Y �-� .5. K. S. f�t0. $7` rki '. � . STA -EMEFN TE:N'S I",� THE WATER SUPPLY-AND SMAC-,E ]DISPOSAL � ' '- - ' v :+' l3k'�- "SYSTEMS -FOR THIS RESfCttI' 1C WtLL CONFORM TO THE STAKbAR'DS -OF THE :a sf�». `� th K CO. DEPT. F HEA T4.StR-VI & ?. O c3 •• $q'• w, SUFFOLK 4 L CE iii 0. %All APPLICANT S,UFFO4_K COUNTY DEPT. OF WA€,:Tfi SERV ICES — FOR A Fq:KR 4'V A'L CKt= CONSTRUCTION ONLY fEdi,71f r DATE; Q -t REF. N0.- CT �` 5.+�� F_, f4 APPROVED: 26 -SUFFOLKLIC Q:TAS, A0 HAti : to T_ -SECT. # iok _ COMPLY WITH A C DE9�J-6, -60 X Z-* .. NEW YORK STATE 8'TC WN CODW.0rrz;' • 4, h AS REQUIRED AND O DIT OF 0 7- • •I''a`,. 6 !4,.•aT f •y f - :•f Y •t !":...,41 i ,.,...� ��F"S•[iw7 C: ' _.,' ?`.•i4f '! %Tr"F'� • -.-_ _ _r, _.._. _..._— i it +• n ,� '; '.•j.. Kum) ' -A � fR; s'`y't 3��f'4:. "��$�•fO.�f�r"� - i `��% �.x_'^•, �-.• � , ..�. ..•g=.,. :'.-_ -.: ,r t OVAD AS NOTED • �,, lam". :`" .> ' `Q _ S F,',p.,Ta"��t , ' '� '� _}''• DATE: P.` '' I G ifs Os INS a}. nzg-P ' FEE: BY: t nt. C'ua:anxees ind1rm,.�c"a�^-' 1 NOTIFY BUILDING DEPART ENT AT t} J`•C.=J�,� .s�� f L { G:: "`�.. ------ S�'.�Gl j is sres:ar�.Mrd•s:-•r, :-. - ; nd 765-1802 8 AM TO 4 PM FOR THE !• / y rr- +' FOLLOWING INSPECTIONS: ( ,yam Q�+ rdr� 1_ �b::a ce:r. ::n•r. ht-, " /] .if' �. V Sf S t►r yG.G f 1��1.•P' J , r 9p t''1 ",l;i� 't8'S u`+ a•,'''t'` '``a: -- - --_-_ ---- - - - 1. FOUNDATION - TWO REQUIRED --- - -- a� �,z' t }.xxs ec io FOR POURED CONCRETE t �' ;t ,� 7 m v"'em.,.,a:.nsutunons 2. ROUGH FRAMING & PLUMBING 3. INSULATION { SZ-AL SUFFOLK COUNTY DEPA OF HEALTH SEWS 4. FINAL - CONSTRUCTION MUST i�� ° Svr7G, SINGLE FAMILY DWELLING ONLY BE COMPLETE FOR C.O. DAT�t�R 1484 H.S. REF. '+t0: $'? S4 $' ALL'CONSTRUCTION SHALL MEET THE .:• ,, ch �'A -. The sewage disposal and water supply facilities for this REQUIREMENTS OF THE CODES OF NEVA ¢ :G? 2$k ",`,$7 f -x_ $ f0 � , , location have teen inspected by this 02Martrr.2nt andlor YORK STATE. NOT RESPONSIBLE FOR r t:,edO-- fur 1 . i;�`$�$ _ oth age ia;and fa:,►d jr, be satisSact�ry. DESIGN OR CONSTRUCTION ERRC Q DER t "] _,0 C o; auraaa of 'Juste ater Management _ ":i; �t3 LANDS11f �I.E°1Et3R5f7' 'LAN 5J C��r�cxrl if•S�:c� t� ,�D r17 SIG .^vfi r �`% t+Q: t,t .fix f9 ' GR itF'£3Ft t~ 'NEW 1AORR TE�OEDYNE fOST WT329 .